Low priority prescribing survey analysis December 2016
Introduction
The CCGs are making some changes in relation to an area called ‘low priority prescribing’ in line with many other NHS organisations in Lancashire and nationally.
The CCGs are proposing to stop the funding of certain types of medicines or treatments that are readily available ‘over the counter’ in pharmacies or on the shelves in shops and supermarkets.
The types of medicines and treatments that fall into this category include:
• Treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets.
• Treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements. Gluten free bread and flour.
In some cases there will still be exceptions to this, such as the prescribing of some of these treatments for people with long term conditions, for babies and children, for breastfeeding mothers or when caring for people at the end of their life.
In order to ensure that the proposals are sound, and the new prescribing policies are appropriate, a survey has been undertaken to capture the views of the local population.
The survey
A total number of 1,400 people completed the online survey (Appendix 1). Hard copies of the survey were provided to participants on request. Not every respondent completed each question. The number of responses received is illustrated next to each question.
Where do respondents live?
Of the 1,400 people completing the survey, a total number of 1,176 people reported where they lived. A breakdown of this is illustrated within Table 1.
People from across Preston, Chorley and South Ribble completed the survey, with the majority of the responders stating that they lived in the Chorley (PR7 and PR 6 localities). A number of responders (224 people) skipped this question. This may be that they were out of area, or didn’t want to divulge this information.
Table 1: Reported locality of responders
Postcode and locality Number of responses PR1 Central Preston and Penwortham 5.3% (63) PR2 North Preston including Lea, Ashton, Fulwood and Grimsargh 4.51% (53) PR3 North Lancs including Great Eccleston, Pilling, Broughton, Goosnargh and Longridge 1.79% (21) PR4 West Preston including Wesham, Kirkham, Warton, Hesketh Bank, Much Hoole, Tarleton 3.06% (36) PR5 East Preston including Samlesbury, Walton-le-Dale, Bamber Bridge, Lostock Hall, Higher Walton 4.68% (55) PR6 East Chorley area including Brindle, Abbey Village, Brinscall, White Coppice, Heath Charnock 18.79% (221) PR7 West Chorley area including Buckshaw Village, Euxton, Eccleston, Heskin, Charnock Richard, Coppull, Adlington 42.77% (503) PR25 Central Leyland, Farrington, Clayton-le-Woods 10.63% (125) PR26 West Leyland including Croston, Bretherton, Farington Moss, Midge Hall and Moss Side 2.64% (31)
How old are survey responders?
The age of participants varied from under 18 years to 93 years and is categorised in Table 2. Out of the 1,400 people completing the survey, a total of 1,178 people stated their age. Most of the people responding to the survey were aged over 26 years, with the highest response rates from people aged over 61 years
Table 2: Age of responders
Age of 18 years and below 19-25 years 26-45 years 46-60 years 61+ years responders Number of 41 34 235 373 493 responses
A total number of 1,188 responders stated their gender as illustrated in table 3. Most of the responders stated that they were female.
Table 3: Gender of responders
Male Female 421 767
Survey Responses
A summary of the responses to each of the questions is detailed below.
Question 1 - do you currently pay for prescriptions?
A total of 1,394 people answered this question. Almost 60% of respondents (806 people) stated that they did not pay for their prescriptions compared to 41% (573 people) that said they do pay.
Answered: 1,394 Skipped: 6
Yes
No
Don’t know
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 41.10% 573
No 57.82% 806
Don't know 1.08% 15 Total 1,394
Question 2 - Do you consider yourself to have a disability or long term condition?
A total number of 1,391 people answered this question. Over 50% of responders (808 people) stated that they had a disability or long term condition, compared to 539 who stated that they don’t. Only nine people skipped this question.
Answered: 1,391 Skipped: 9
Yes
No
Prefer not to say
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 58.09% 808
No 38.75% 539
Prefer not to say 3.16% 44 Total 1,391
Question 3 - Are you a carer or someone who has a carer?
A high proportion of people (1,384) completing the survey answered this question. Most responders stated that they were not a carer or someone with a carer (81%). Only 16% of responders stated they were either carers or cared for.
Answered: 1,384 Skipped: 16
Yes
No
Prefer not to say
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 16.18% 224
No 81.29% 1,125
Prefer not to say 2.53% 35 Total 1,384
Question 4 - Are you a parent?
Out of the 1,385 people that responded to this question, almost 70% (966 people) stated that they were a parent.
Answered: 1,385 Skipped: 15
Yes
No
Prefer not to say
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 69.75% 966
No 28.59% 396
Prefer not to say 1.66% 23 Total 1,385
Question 5 - Would you consider yourself to be in the category of either 'maternity', 'pregnancy' or 'breastfeeding mother'?
Almost all responders (96%) stated that they were not in the 'maternity', 'pregnancy' or 'breastfeeding category.
Answered: 1,388 Skipped: 12
Yes
No
Prefer not to say
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 1.44% 20
No 96.18% 1,335
Prefer not to say 2.38% 33 Total 1,388
Question 6 - Do you have coeliac disease?
Under 10% of people responding to the survey stated that they had coeliac disease.
Answered: 1,381 Skipped: 19
Yes
No
Prefer not to say
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 8.18% 113
No 89.21% 1,232
Prefer not to say 2.61% 36
Total 1,381
Question 7 - Please state if you think we should stop prescribing the medicines and treatments in the list below.
Of the 1,334 responses received, most people stated that the prescribing of the medicines and simple treatments listed below should be stopped.
Answered: 1,334 Skipped: 66
Simple pain killers
Pain relief gels, creams and sprays
Antihistamine tablets, capsules and liquids
Nasal sprays for allergies
Vitamins, minerals and health supplements
Toothpastes, mouthwashes and mouth gels
Sore throat and mouth ulcer products
Nasal decongestant sprays, tablets and capsules
Sun protection creams, lotions and sprays
Warts and verruca treatments
Antiperspirants
Cosmetic moisturisers
Cough syrups, linctus and mixtures
Ear wax removers
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes No Don't know
Yes No Don't know Total
79.79% 17.36% 2.85% Simple pain killers 1,062 231 38 1,331
65.63% 28.16% 6.21% Pain relief gels, creams and sprays 867 372 82 1,321
59.61% 33.56% 6.83% Antihistamine tables, capsules and liquids 785 442 90 1,317
55.48% 35.63% 8.89% Nasal sprays for allergies 724 465 116 1,305
82.31% 14.29% 3.40% Vitamins, minerals and health supplements 1,089 189 45 1,323
86.97% 9.64% 3.39% Toothpastes, mouthwashes and mouth gels 1,155 128 45 1,328
77.81% 18.47% 3.72% Sore throat and mouth ulcer products 1,024 243 49 1,316
71.03% 23.42% 5.55% Nasal decongestant sprays, tablets and capsules 934 308 73 1,315
89.20% 8.08% 2.72% Sun protection creams, lotions and sprays 1,181 107 36 1,324
67.33% 27.43% 5.24% Warts and verruca treatments 886 361 69 1,316
Antiperspirants 88.59% 7.79% 3.63%
1,172 103 48 1,323
85.90% 9.70% 4.40% Cosmetic moisturisers 1,133 128 58 1,319
81.69% 14.90% 3.40% Cough syrups, linctus and mixtures 1,080 197 45 1,322
Ear wax removers 72.78% 21.23% 5.99%
960 280 79 1,319
Question 8 Do you have any comments about this proposal? (medicines and treatments)
A total of 681 comments have been received. Common themes in favour of stopping the prescribing of these medications and treatments include:
These are available on the NHS These are cheaper to buy over the counter It will save the NHS a lot of money that can be used on other treatments Anything available over the counter that is cheaper than a prescription should be stopped Will save GP time (appointments)
Patients told us:
“A great idea” and “the sooner the better” “A sensible idea” “Will help reduce cost to the NHS” “Gob-smacked - I didn’t realise that you (NHS) prescribed all these” “Won’t need a GP appointment”
There was, however, some concern about stopping the prescribing of these products. Common themes include:
Some people on lower incomes may not be able to afford to buy these over the counter Elderly people may not be able to afford to pay for these People with long term conditions or serious allergies should have them on prescription
Comments made by members of the public included:
“Protection must be in place for people on low incomes” “The end of this will affect the most vulnerable” “These should be prescribed for the elderly”
Question 9 - It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)
Most people who responded to the survey described themselves as local residents. Almost a third of responders (351 people) stated they were prescribed one or some of these medications or treatments on the NHS, with almost 20% (247) stating that they knew someone prescribed one or some of these.
Answered: 1,297 Skipped: 103
I am currently prescribed one or some of these treatments on the NHS
Someone I care for is prescribed one or some of these treatments on the NHS
Someone I know is prescribed one or some of these treatments on the NHS
I am a healthcare professional
I am a local resident
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
I am currently prescribed one or some of these treatments on the NHS 27.06% 351
Someone I care for is prescribed one or some of these treatments on the NHS 11.64% 151
Someone I know is prescribed one or some of these treatments on the NHS 19.04% 247
I am a healthcare professional 13.18% 171
I am a local resident 78.64% 1,020
Total Respondents: 1,297
Question 10 - Do you agree with the proposal to stop prescribing gluten free foods (bread and flour) on the NHS in Chorley, South Ribble and Greater Preston?
A total of 1,312 people answered this question. Over half of the responders (56%) stated that the prescribing of gluten free foods should be stopped. From the number of responders who disagreed with the proposal to stop prescribing these products (357), 103 responders stated that they had celiac disease.
Answered: 1,312 Skipped: 88
Yes
No
Don't know
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 56.10% 736
No 27.21% 357
Don't know 16.69% 219
Total 1,312
Question 11 - Do you have any comments about this proposal? (gluten free foods)
A total of 637 comments were received. Common themes in favour of stopping prescribing gluten free foods include:
These are available to buy in a supermarket It will save the NHS a lot of money Gluten free products are readily available to buy Find an alternative – bread and wheat based products are not a necessity It’s a life choice to eat bread/ wheat based products
Comments included
“Amazed that these are prescribed” “everyone pays for their food” “Seems sensible to me” “Gluten free products are widely available” “It is possible to do without bread in a diet”
A small number of respondents who stated that they had coeliac disease supported the proposal, and told us: “I am coeliac and there is a wide variety of gf foods readily available in supermarkets” “Gluten Free food is now readily available from supermarkets” “The NHS cannot fund everything for everybody” Almost all of the people in favour of prescribing gluten free foods stated that they were either prescribed gluten free foods on the NHS, cared for people prescribed with these products, or knew someone who were prescribed these products (see question 12). Common themes opposing the proposal to stop prescribing gluten free products include:
Coeliac disease is an autoimmune disease, not just a food intolerance It’s false economy, may provide a short term cost-saving but the knock on effect will have bigger cost implications for the NHS (i.e. referrals to other services) Cost - gluten free products are more expensive People with coeliac disease feel that they are being punished - diets will suffer It’s a way of life for people with coeliac disease Cost - these foods are expensive to buy from a supermarket Some people on lower incomes may not be able to afford to buy these products They should be available for children Coeliac disease is not a choice and should be supported by the NHS to manage the condition Patients told us:
“Foods provided on prescription are fortified with vitamins and are safe from cross contamination unlike supermarket versions” “I find gluten free products expensive. I feel like a second class citizen”
“We are on low income, a prescription is vital”
Some respondents have suggested prescribing a limited number of gluten free foods to patients that meet certain, agreed criteria.
Question 12 It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)
Most people (1,019) responding to the survey stated that they were local residents. Just over a quarter of responders (329) stated that they were prescribed gluten free products, were a carer for someone, or knew someone that had been prescribed these products.
Answered: 1,245 Skipped: 155
I am currently prescribed gluten free foods on the NHS
Someone I care for is prescribed gluten free foods on the NHS
Someone I know is prescribed gluten free foods on the NHS
I am a healthcare professional
I am a local resident
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
I am currently prescribed gluten free foods on the NHS 7.63% 95
Someone I care for is prescribed gluten free foods on the NHS 2.73% 34
Someone I know is prescribed gluten free foods on the NHS 16.06% 200
I am a healthcare professional 13.17% 164
I am a local resident 81.85% 1,019
Total Respondents: 1,245
Appendix 1 Low priority prescribing survey
Low priority prescribing - Your views...
Introduction
The CCGs in Chorley, South Ribble and Greater Preston (central Lancashire) are making some changes in relation to an area called ‘low priority prescribing’ in line with many other NHS organisations in Lancashire and nationally.
What this means is that they are proposing to stop the funding of certain types of medicines or treatments that are readily available ‘over the counter’ in pharmacies or on the shelves in shops and supermarkets.
The types of medicines and treatments that fall into this category include: Treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets. Treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements. Gluten free bread and flour. In some cases there will still be exceptions to this, such as the prescribing of these treatments for people with long term conditions, for babies and children, for breastfeeding mothers or when caring for people at the end of their life.
Before these changes are made, we would like to gather your views to help us make sure that the proposals are sound and the new prescribing policies are appropriate, and also to inform any other information or interventions we may need to put in place.
The survey will close on Monday 21 November 2016, and a feedback report from the engagement exercise will be published in early December.
If you would like to get in touch with us about this survey or anything else in relation to your local health service, please contact one of the email addresses below: en [email protected] [email protected]
Low priority prescribing - Your views...
Your views...
Low priority prescribing - Your views...
Treatments for minor ailments or treatments with limited clinical benefits
7. Please state if you think we should stop prescribing the medicines and treatments in the list below:
Yes No Don't know
Simple pain killers
Pain relief gels, creams and sprays
Antihistamine tables, capsules and liquids
Nasal sprays for allergies
Vitamins, minerals and health supplements
Toothpastes, mouthwashes and mouth gels
Sore throat and mouth ulcer products
Nasal decongestant sprays, tablets and capsules
Sun protection creams, lotions and sprays
Warts and verruca treatments
Antiperspirants
Cosmetic moisturisers
Cough syrups, linctus and mixtures
Ear wax removers
8. Do you have any comments about this proposal?
9. It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)
I am currently prescribed one or some of these treatments I am a healthcare professional on the NHS I am a local resident Someone I care for is prescribed one or some of these treatments on the NHS
Someone I know is prescribed one or some of these treatments on the NHS
Low priority prescribing - Your views...
Gluten free foods
10. Do you agree with the proposal to stop prescribing gluten free foods (bread and flour) on the NHS in Chorley, South Ribble and Greater Preston?
Yes No Don't know
11. Do you have any comments about this proposal?
12. It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)
I am currently prescribed gluten free foods on the NHS I am a healthcare professional
Someone I care for is prescribed gluten free foods on the I am a local resident NHS
Someone I know is prescribed gluten free foods on the NHS